Healthcare Provider Details

I. General information

NPI: 1558049213
Provider Name (Legal Business Name): CHEYENNE COLBY WESTLAKE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8105 E 68TH ST
TULSA OK
74133-2236
US

IV. Provider business mailing address

6502 S YALE AVE STE 3410
TULSA OK
74136-8329
US

V. Phone/Fax

Practice location:
  • Phone: 918-727-2810
  • Fax: 918-501-8097
Mailing address:
  • Phone: 918-499-4855
  • Fax: 918-488-6098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number214712
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number214712
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: